Harvey James of Pure Dental Lab in Surrey discusses his digital journey.
Like most metalwork technicians I love working with gold. It’s a beautiful material and to be honest, I never thought the day would come in my working life when gold would be superseded by non-precious alloys. But digital dentistry has revolutionised our working practices in so many ways.
Gold might be a lovely material, but it’s expensive and time-consuming to work with. As a lab, we produce a considerable volume of implant-borne restorations, most of which are on Straumann fixtures. If we use a gold cylinder costing £200 and spend a further £100 on gold for the abutment, that’s £300 before you’ve even started! For years, I’d been asking Straumann to produce Cobalt Chrome abutments and when they launched Straumann® Variobase™ this provided a solution in some cases. However, it still didn’t provide the flexibility a custom abutment could deliver.
In May 2014, I was lucky enough to attend the ITI World Congress in Geneva and at this meeting I stumbled across Createch Medical who were demonstrating milled chrome abutments. I thought to myself, “That’s it – that’s what this industry has been looking for the last 50 years.” I come from an engineering family, my Dad’s an engineer and a lot of what I do is engineering. I’ve always looked at things from an engineering point of view. You can’t argue with the tolerances of a machine; you cannot recreate what a machine can do by hand. Not from a milling point of view – it’s impossible.
Partnering with the best
I started working with Createch by sending diagnostic wax-ups to them for scanning and milling. The fit was fantastic, but on many occasions we would be spending half an hour or so trimming and refining the restoration, but ultimately we’d end up with something that fitted better than anything cast. We worked alongside Createch to refine this process by waxing up exactly what I was looking for and challenging them to copy it.
They would copy my wax up but then I’d have to go back to them and say, “you’ve missed this bit off that I’ve waxed, you probably didn’t realise I needed it”. Backwards and forwards we went. Now three years later we’re producing some fabulous work with their help and we now scan everything in-house.
I wouldn’t want to see all dental technicians assimilated in to a ‘Borg’-like collective, but resistance to digital technology in dentistry is futile. I understand that technicians are worried that their jobs may be lost and that to stay in dentistry they need to retrain to keep up, but this is the world we live in. There are so many advantages to working in a digital environment. It’s a lot cleaner for one and we can produce highly accurate restorations that save us all time and money. For me, it’s a very exciting time as I have a wealth of ‘old school’ knowledge and this is now joining forces with the advances in technology. I have swapped my wax knife and Le Cron for a computer and screen and I’m enjoying the journey. 100% of my lab’s metal work is now produced using CADCAM process and I wouldn’t want to go back to the pitfalls of investing and casting!
We were probably quite slow to adopt in-house scanning. We bought our first Straumann scanner in 2014 but didn’t really use it, it just sat on the bench to be used for the occasional zirconia coping. As we began working more with Createch, Straumann launched the CS2 scanner and it was at this point that we started to really get our teeth (sorry about the pun) in to digital dentistry as we could see the benefits for us a business, our clients and their patients. Straumann has nailed the validated workflow, their in-house milling and partnership with Createch is amazing. We’ve also found that the support from Straumann is excellent and has helped us get the most from our equipment through the many services they provide. They’ve never once walked away from any problems we’ve had and I’ve built-up a fantastic rapport with both Createch and Straumann, which to me is invaluable.
End-to-end digital dentistry
Our digital journey has snowballed and we’ve invested in numerous pieces of digital equipment including the Amann Girrbach Ceramill Motion2 milling machine which we use to mill wax patterns for e.max pressings. Amann Girrbach have partnered with Straumann to offer dental laboratories the capability of milling in-house via Straumann CARES®, with original Straumann connections using state-of-the-art materials. At the heart of the collaboration is a five-axis in-lab milling machine – the “Straumann CARES® M Series by Amann Girrbach”. Although the milling unit can mill a wide range of materials including e.max, we find that milling wax patterns, investing and then pressing provides us with a more cost-effective and controlled process. The results are amazing!
We have recently purchased the Rapidshape 3D printer from Straumann for model production. We are excited to be using this technology and as more clinicians adopt intra-oral digital scanning equipment, we will be getting closer to an end-to-end digital solution. We design models using the Dental Wings software and 3D printing via our Rapidshape unit, which all forms part of the Straumann validated workflow. Many clinicians still don’t have access to a digital scanner, but recent research[i] suggests that adoption is speeding up as over 15% of clinicians surveyed said they plan to purchase an intra-oral scanner in the next 12 months. It’s certain that this trend will continue and there will be mass adoption of digital technology in the coming years, so labs need to prepare now or be left behind.
I realise it can be difficult to change your business model, but I firmly believe we should see this as a positive change that improves the restorations we produce and makes our labs more profitable in the longer term.
Attracting new clients
All businesses need to attract new clients and being involved in digital dentistry can be a great way of getting access to a younger audience. At last year’s Straumann Platinum Technicians event we were treated to an excellent presentation that discussed the marketing benefits of Facebook, Instagram and Twitter. Some of this fell on deaf ears as some of the audience seemed to think social media wasn’t for them. However, I find these mediums invaluable and it’s giving me an opportunity to interact and showcase my work with younger clinicians who are all over these channels. As technicians, we have a wealth of knowledge that we can share and help younger clinicians especially understand the materials and processes available to them. At dental school clinicians traditionally learn very little about digital dentistry, but as millennials they are very keen to learn more once in general practice and they certainly can see the benefits.
Don’t talk to me before 11!
I’ve seen the benefits of digital technology, but what’s the downside? The downside, if there is one, is that you need to change your mindset as you’re outsourcing an element of your production and this is counter-intuitive to most technicians. Before my journey in to digital technology I could wax about 20 copings in an average 10-hour day, now I scan more than 20 copings in less than 2 hours! Every one of these scanned copings is beautiful quality and the only slight negative is that we need to wait for them to be delivered by courier. I scan every day between 7 – 11am and this work is then delivered to the lab between 48 and 74 hours later, so it’s important to make sure the lab organisation is spot on to accommodate this turnaround time. We’ve now got used to this change in organisation and I love it… After 11am I can prepare for the next day and turn to my life passion cycling, which is fantastic in comparison to having my head down at the bench for 10 or 11 hours a day!
Happy to help
I’ve had lots of help along my digital journey from Straumann and Createch in particular, and I would be happy to offer advice to any technician wanting to know more about the advantages and processes of digital dentistry. I would also suggest that technicians visit the Dentistry Show in May to see for themselves the array of new digital technology… Now is the time to step on to the digital super highway!
For further information about Straumann® CARES® Digital Solutions visit www.straumanndigitalperformance.co.uk
[i] BDIA Technology & Trends in The Dental Surgery Survey 2017